Department and Institute of Psychiatry, Clinical Hospital, University of São Paulo Medical School, São Paulo, Brazil.
J Anxiety Disord. 2012 Jan;26(1):25-31. doi: 10.1016/j.janxdis.2011.08.008. Epub 2011 Aug 19.
Clinical effectiveness of group cognitive-behavioral therapy (GCBT) versus fluoxetine in obsessive-compulsive disorder outpatients that could present additional psychiatric comorbidities was assessed. Patients (18-65 years; baseline Yale-Brown Obsessive-Compulsive-Scale [Y-BOCS] scores ≥ 16; potentially presenting additional psychiatric comorbidities) were sequentially allocated for treatment with GCBT (n=70) or fluoxetine (n=88). Mean Y-BOCS scores decreased by 23.13% in the GCBT and 21.54% in the SSRI groups (p=0.875). Patients presented a mean of 2.7 psychiatric comorbidities, and 81.4% showed at least one additional disorder. A reduction of at least 35% in baseline Y-BOCS scores and CGI ratings of 1 (much better) or 2 (better) was achieved by 33.3% of GCBT patients and 27.7% in the SSRI group (p=0.463). The Y-BOCS reduction was significantly lower in patients with one or more psychiatric comorbidities (21.15%, and 18.73%, respectively) than in those with pure OCD (34.62%; p=0.034). Being male, having comorbidity of Major Depression, Social Phobia, or Dysthymia predicted a worse response to both treatments. Response rates to both treatments were similar and lower than reported in the literature, probably due to the broad inclusion criteria and the resulting sample more similar to the real world population.
评估了团体认知行为疗法 (GCBT) 与氟西汀治疗伴有潜在共病精神障碍的强迫症门诊患者的临床疗效。患者（18-65 岁；基线耶鲁-布朗强迫症量表 [Y-BOCS] 评分≥16；可能存在其他共病精神障碍）先后被分配接受 GCBT（n=70）或氟西汀（n=88）治疗。GCBT 组的 Y-BOCS 评分平均下降 23.13%，SSRI 组下降 21.54%（p=0.875）。患者共存在 2.7 种精神共病，81.4%至少存在一种其他障碍。GCBT 组有 33.3%和 SSRI 组有 27.7%的患者达到 Y-BOCS 基线评分至少下降 35%和 CGI 评分 1（明显好转）或 2（好转）。有 1 种或更多精神共病的患者 Y-BOCS 评分下降显著低于仅有强迫症的患者（分别为 21.15%和 18.73%）（p=0.034）。男性、共患重性抑郁障碍、社交恐惧症或心境恶劣障碍预示着对两种治疗的反应更差。两种治疗的反应率与文献报道相似且低于文献报道，可能是由于纳入标准广泛，导致样本更接近真实世界人群。
